Cinemax’s new series, The Knick, wastes no time in establishing that its main character, Dr. John Thackery (Clive Owen) is TV’s newest antihero, someone you may not be entirely comfortable rooting for as the series progresses.

The show opens in 1900 New York City with Thackery in an opium den, and just to remind you this is premium cable, a naked prostitute walks into view to let him know that it’s time for him to get up for work. He then finds a taxi and tells the driver which way to take him to the “The Knick” (or Knickerbocker Hospital). When the driver says there’s a shorter way to get there, Thackery tersely responds that he wants the longer way because he enjoys waiting.

Is that because Thackery enjoys the scenery of the developing metropolis, the hustle and bustle of the city with its crowded streets? (Watch out for the dead horses, by the way.) Nope — he wants to sit in traffic because it gives him time to shoot cocaine between his toes (and presumably enjoy the high). Who is this guy?

Perhaps you already know from the trailers and advertising (though the marketing didn’t make it entirely clear what The Knick was truly about) that Owen’s character is a surgeon. Though given his bloody hands and the gritty setting portrayed in some of the ads, we don’t know if Thackery is a good surgeon. Maybe he’s a butcher, if for no other reason than the primitive techniques and equipment of the time.

As it turns out, Thackery is considered a brilliant surgeon, engaging in innovative procedures with his mentor, Dr. Christenson (Matt Frewer). Yet because they’re taking chances, some of these surgeries are potentially dangerous — even fatal. The toll of failure and the loss of lives apparently takes its toll on Christenson, who decides he’d rather not do this anymore in the most final way possible.

That makes Thackery chief of surgery at The Knick, a position which surely suits his skills, but he seems to wonder if he can handle the responsibility without Christenson there to encourage and push him. (Oh, and shoot cocaine with him. Thackery apparently picked up more than the best surgical techniques and medical practices from his mentor.)

But Thackery moving up to the big chair creates an opening in his old position, and that leads us towards the politics and tensions that will surely help make The Knick a richer, more interesting series than one which only follows a gifted, yet flawed surgeon with a serious drug habit.

Thackery already has someone in mind for his old job, seeing a natural promotion for another top surgeon on the team, Dr. Gallinger (Eric Johnson). Yet the chief benefactor of the hospital, Cornelia Robertson (Juliet Rylance), has a far more different and controversial choice she’d like to see take the deputy chief position. Dr. Algernon Edwards (André Holland) is a Harvard-educated surgeon who’s trained in the latest advanced techniques during a stint in London.

Oh, Edwards is also black. Is that an issue? It appears to be with Thackery. So in addition to being a drug addict who prefers to spend his nights in brothels, our good doctor is also apparently a racist. Thackery justifies his prejudice by pointing out that no patient would let Edwards work on him or her, but this story development shows that the new chief of surgery isn’t as open-minded as a man in his position probably should be.

Yet the decision isn’t really up to Thackery. Edwards is forced upon him by his boss, fueled by the threat of the Robertsons pulling much needed funding and manpower for electrical upgrades to the hospital.

Despite the humiliation, rejection and resentment from his colleagues, Edwards wants to work at The Knick because of its reputation as a teaching hospital. That desire only increases after watching Thackery perform an emergency surgery with a new instrument he created. Though Edwards initially had no interest in staying where he wasn’t wanted, he’s now not going anywhere until he learns everything Thackery knows.

Unknown to all but the young nurse who had to retrieve him, Thackery also performed the procedure after taking a hit of cocaine which quieted down his withdrawal pains. However, it’s possible that others at the hospital know of Thackery’s proclivities. That could be an intriguing subplot for the rest of the season.

All of these characters and plotlines combine to make The Knick a curious take on the typical hospital drama. Shows like ER, House, and Grey’s Anatomy portrayed their doctors as heroes (though flawed in their personal lives) while also addressing the realities of the health care system and administrative politics in their stories. Obviously, the 1900 setting sets The Knick apart from its fellow medical dramas.

It can also be a hell of a lot bloodier, since it’s on premium cable, and director Steven Soderbergh — enjoying his “retirement” from making movies — seems intent on showing just how sloppy and grisly medicine could get more than a hundred years ago. Hopefully, we avoid the lawyers and heart-tugging children with terminal illnesses in this one. I’m guessing Soderbergh has no interest in those tropes either.

The Knick is a daring venture for Cinemax, which seemed content to be the home of over-the-top action dramas like Banshee and Strike Back. A prestige drama like this seemed better suited to sister network HBO, but Soderbergh smartly realized that this show would stand out more elsewhere and likely get better promotion. Cinemax is giving The Knick a big push, putting the pilot episode on YouTube for free and also playing it on HBO last week.

Will viewers seek the show out on a channel not normally associated with such programming, especially on Friday nights? DVRs and streaming TV might help overcome those two obstacles. Soderbergh gives the show impressive credibility as well, and him directing all 10 episodes of the series’ first season (it’s already been renewed for a second) ensures a consistent tone and vision.

It’s difficult — and unfair — to judge a series after one episode. The Knick‘s pilot does take a little while to get going, which might compel some people to give up. But the show has given itself a lot to work with and much to build on. Now that the general premise and main characters have been established, the story can drive forward. The promise of that, as well as the involvement of Soderbergh and Owen, should be enough to keep tuning in.

About Ian Casselberry

Ian is an editor for The Comeback and Awful Announcing, also covering baseball at The Outside Corner and pop culture for The AP Party. He has written for Yahoo! Sports, MLive.com, Bleacher Report and SB Nation, and provides analysis for several sports talk radio shows each week. He currently lives in Asheville, NC.